The accuracy of patient-reported measures for GI symptoms: a comparison of real time and retrospective reports.

BACKGROUND: Obtaining accurate information about gastrointestinal (GI) symptoms is critical to achieving the goals of clinical research and practice. The accuracy of patient data is especially important for functional GI disorders (e.g., IBS) whose symptoms lack a biomarker and index illness severity and treatment response. Retrospective patient-reported data are vulnerable to forgetting and various cognitive biases whose impact has not been systematically studied in patients with GI disorders. The aim of this study was to document the accuracy of patient-reported GI symptoms over a reporting period (1 week) most representative of the time frame used in research and clinical care. METHODS: Subjects were 273 Rome III-diagnosed IBS patients (mean age = 39 years, 89% F) who completed end of day GI symptom ratings for 7 days using an electronic diary. On Day 8, Subjects recalled the frequency and/or intensity of IBS symptoms over the past 7 days. Reports were then compared against a validation criterion based on aggregated end of day ratings. KEY RESULTS: At the group level, subjects recalled most accurately abdominal pain and urgency intensity at their worst, urgency days, and stool frequency. When data were analyzed at the individual level, a subgroup of subjects had difficulty recalling accurately symptoms that showed convergence between recall and real time reports at the group level. CONCLUSIONS & INFERENCES: Although many patients' recollection for specific GI symptoms (e.g., worst pain, stool frequency) is reasonably accurate, a non-trivial number of other symptoms (e.g., typical pain) are vulnerable to distortion from recall biases that can reduce sensitivity of detecting treatment effects in clinical and research settings.

Correlates of markers of oxidative status in the general population.

Oxidative stress has been implicated in the etiology of many chronic diseases, including cardiovascular disease. However, limited information exists on the factors that may influence oxidative status in the general population. In a random sample of the population of two counties in western New York, levels of several markers of oxidative status (i.e., thiobarbituric acid-reactive substances, erythrocyte glutathione, and glutathione peroxidase) were determined. A total of 894 men and 903 women aged 35-79 years were included in the study (1996-1999). In addition, a number of sociodemographic and lifestyle characteristics and cardiovascular disease risk factors were measured. Age, markers of glucose metabolism (e.g., plasma glucose level) and insulin resistance (e.g., serum triglycerides, high density lipoprotein cholesterol, body mass index), and postmenopausal status in women were associated with increased oxidative stress and reduced antioxidant potentials. Oxidative status and antioxidant potentials appear to be significantly associated with a number of major cardiovascular disease risk factors; most of them are linked to abnormalities in glucose and insulin metabolism.

The relative influence of perceived pain control, anxiety, and functional self efficacy on spinal function among patients with chronic low back pain.

STUDY DESIGN: A prospective analysis of the relative influence of pain-specific and performance-specific cognitive variables on lifting tasks using empirically derived measures. OBJECTIVES: To determine the relative contributions of self efficacy expectancies of lifting performance, perceptions of pain control, and anxiety on actual lifting performance. SUMMARY OF BACKGROUND INFORMATION: Although patients' pain beliefs play an important role in the expression of low back pain, there is little research on the influence of performance-specific cognitions on spinal function. This study extended the scope of recent research, with findings indicating that patients with a stronger functional self efficacy expectancy--the belief that one can perform essential work tasks successfully--achieve higher levels of function than those with a low functional self efficacy expectancy. Moreover, as a performance-specific variable, functional self efficacy expectancy was hypothesized to be a better predictor of lifting than pain-specific cognitions, which presumably influence function in an indirect manner, if at all. METHODS: Before undergoing a standardized, graded lifting assessment, 100 work-disabled patients with chronic back pain rated their confidence to perform load-lifting tasks essential to their job (functional self efficacy expectancy), their ability to control and decrease pain, and psychological distress. RESULTS: Multiple regression analyses found that functional self efficacy expectancy accurately predicted lifting. It was found to be a better predictor of lifting tasks than either of the perceived pain control measures or psychological distress. CONCLUSION: Data suggest that what patients believed they could achieve accurately determined their actual spinal function, independent of their sense of control over pain or their distress. Approaches to low back disorders emphasizing perceived pain control as a central cognitive determinant of disability were unsupported.

Smoking attitudes, beliefs, and readiness to change among acute and long term care inpatients with psychiatric diagnoses.

The present study represents an initial assessment of barriers and motives for quitting, health risk knowledge, and readiness to change in a hospitalized acute and long term care population with psychiatric diagnoses, and dual diagnoses of substance abuse and psychiatric disorders. Ninety-two patients residing in admissions, long term care, and mentally impaired/chemically addicted (MICA) units of a VA Medical Center were interviewed by nursing staff. Among the 78% of patients who smoke (smokers), 68% believed smoking was harmful and quitting would benefit their health. The majority of smokers were in Precontemplation (53%) or Contemplation (24%). Smokers in the MICA unit were more similar to the general population in smoking related beliefs and were more likely than other smokers to be in Preparation. These results indicate a need for educational and motivational enhancement interventions for the majority of smokers hospitalized for psychiatric disorders.

Relations among alcohol consumption measures derived from the Cognitive Lifetime Drinking History.

Few studies have been conducted of chronic alcohol effects on health and social outcomes. To evaluate the utility and feasibility of such studies, correlations between lifetime and current measures of total alcohol consumption (ounces) and times intoxicated were examined to determine whether these dimensions of drinking are distinct. Studies were conducted in 2142 respondents ages 35 to 70 selected from lists of licensed drivers and individuals eligible for Medicare. Lifetime measures of alcohol consumption and times intoxicated were derived from the Cognitive Lifetime Drinking History (CLDH). Depending on age and sex of the subgroups examined, current consumption accounted for only about 10-25% of the variability in lifetime alcohol consumption; current and lifetime times intoxicated were even less highly correlated. Lifetime and current measures of alcohol consumption accounted for approximately 40-50% of the variability in corresponding lifetime and current measures of times intoxicated in younger cohorts, but this fell to 25% and less in older cohorts. These findings support the use of lifetime measures of alcohol consumption and times intoxicated based on the CLDH together with current measures to investigate chronic and acute alcohol effects on health and social outcomes.

Self-help interventions for older smokers.

OBJECTIVE: To evaluate the relative effectiveness of two self-help smoking interventions as adjuncts to a self-help manual and telephone support service (hotline) for older smokers. DESIGN: Subjects were stratified on baseline variables and randomised to one of two treatment conditions in a methods development study. SUBJECTS: 177 community-dwelling smokers aged 60 years and older. INTERVENTIONS: All subjects received a self-help manual and access to a smokers' telephone hotline. Subjects also received either mailings (Letters condition) or counselling telephone calls (Proactive condition) at four and eight weeks after enrollment. MAIN OUTCOME MEASURES: Use of the hotline and prevalence of abstinence lasting at least 48 hours (verified by a "significant other") were assessed at three and six months for the full sample. Seven-day abstinence was calculated for comparison with previous research. A subsample of 91 subjects was followed up at 12 months. RESULTS: Overall abstinence rates for the two conditions were in the range of typical self-help interventions. Men were more likely to be abstinent than women at follow up at three and six months. A significant gender x treatment interaction was found, with abstinence rates higher for men in the Letters condition, and women in the Proactive condition. Hotline use was high, with nearly half of subjects calling by 12 months. CONCLUSION: Both interventions appear promising for older smokers, but may be differentially effective for men and women. Older smokers will use a hotline; whether Letters and Proactive interventions can improve on manual and hotline effectiveness rates alone is being tested in a subsequent controlled trial.

Pain expectancies, pain, and functional self-efficacy expectancies as determinants of disability in patients with chronic low back disorders.

This study tested the relative predictive power of self-efficacy expectations of physical capabilities (functional self-efficacy [FSE]), expectations of pain, and expectations of reinjury on physical function in chronic back patients. Before behavioral assessment of function, 85 patients rated their abilities to perform essential job tasks (FSE) and the likelihood that their performances would be accompanied by pain and reinjury. Partial correlations revealed that FSE was significantly related to function when reinjury and pain were partialed out. Neither reinjury nor pain expectancies correlated significantly with function when FSE was partialed out. Further support for an FSE approach came from regression analyses that found pain intensity, gender, and FSE--not expected pain or reinjury--related consistently with physical performance. Thus, performance-specific cognitions may have greater explanatory power over disability than pain-specific ones.

Predicting post treatment spinal strength and flexibility in work-disabled low back pain patients.

This study examined whether posttreatment trunk strength and flexibility could be predicted from initial trunk strength and flexibility, age, gender, pain severity, diagnosis, length of work disability, return-to-work expectations, anxiety, and fear of reinjury among a group of 96 injured workers with chronic occupational low back pain who completed a multidisciplinary work rehabilitation program. The results indicate that initial average torque in trunk extension, age, gender, and average pain severity contribute significantly to prediction of final average torque in trunk extension. Initial average torque in trunk flexion, age, and gender contributed significantly to prediction of final average torque in trunk flexion, and age and initial range of motion contributed significantly to the prediction of final trunk range of motion. The results indicate that prediction of trunk strength and range of motion can be accomplished from measures of trunk strength and flexibility and pain obtained prior to the onset of rehabilitation. Psychological measures were not predictive of posttreatment trunk strength and flexibility. The ability to predict posttreatment trunk strength should facilitate clinical decision making in these complex cases.

Multidisciplinary rehabilitation of chronic work-related upper extremity disorders. Long-term effects.

The prevalence of work-related upper extremity disorders has significantly increased in the past decade. Persistent pain, loss of function, and associated work disability in patients with work-related upper extremity disorders appears to be affected by multiple factors including physical capabilities in relation to work demands, ergonomic risk factors on the job, and psychological factors related to worker traits, psychological readiness to return to work, and ability to manage symptoms. The complex nature of these disorders suggests the utility of a multidisciplinary program targeted at these factors. The present study is an investigation of the long-term vocational outcome of a multicomponent rehabilitation program that includes physical conditioning, work conditioning, work-related pain and stress management, ergonomic consultation, and vocational counseling/placement. Two groups equivalent on measures of duration of work disability, pain severity, fear of reinjury, psychological distress, perceived work environment, age, and education level were exposed to either the comprehensive work rehabilitation intervention (n = 19) or usual care (n = 15). Return-to-work status was determined at an average of 17 months posttreatment (range, 3 to 35 months) for the treatment group and an average of 18 months postevaluation (range, 5 to 30 months) for the usual care group. Findings indicated that 74% of the treatment group returned to work or were involved in state-supported vocational training in contrast to 40% of the control group (P < .05). For those who returned to work, 91% of the treatment group were working full-time in contrast to 50% of the control group (P < .05). Although the treatment group demonstrated a higher return-to-work rate than controls, the work reentry rate was not as high as similar approaches with work-related low back pain (80% to 88% return-to-work rate). These findings suggest the need to modify treatment components to facilitate an increased return-to-work rate. Areas that may prove useful include a greater emphasis ergonomic modifications at the workplace to reduce the risks of repetitiveness, force, awkward posture, and insufficient work/rest cycles, as well as efforts to modify work style directly in order to reduce the impact of ergonomic stressors on the ability to perform essential job tasks. In combination with traditional work hardening efforts directed at improving strength and flexibility of the upper extremities and work-related pain and stress management training, these ergonomic and work-style modification efforts may contribute to increases in the percentage of work disabled cases who successfully return to competitive work.